人工颈椎间盘角对人工颈椎间盘置换术后远期疗效的影响
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摘要
目的探讨人工颈椎间盘角对人工颈椎间盘置换术(cervical artificial disc replacement,CADR)后远期疗效的影响。方法回顾分析2003年12月—2007年12月71例行单节段Bryan假体CADR且随访超过10年的患者临床资料,其中男44例,女27例;年龄26～69岁,平均45.9岁。根据术后出院前侧位X线片测量的人工颈椎间盘角结果将患者分为后凸组(人工颈椎间盘角为负值)和非后凸组,比较两组患者术前和末次随访时以下指标:影像学指标[颈椎整体活动度、手术节段活动度、手术节段Cobb角(负值表明手术节段存在局部后凸畸形)、椎旁骨化(paravertebral ossification,PO)分级(3、4级为高等级)];临床功能指标[日本骨科协会(JOA)评分、颈椎功能障碍指数(NDI)、整体疗效评估(Odom评分)]。结果71例患者分为后凸组24例、非后凸组47例,两组患者性别、年龄、手术节段等一般资料比较差异无统计学意义(P>0.05),具有可比性。两组患者均获随访,随访时间121～165个月,平均128个月。术前两组患者颈椎整体活动度及手术节段活动度比较,差异均无统计学意义(P>0.05);后凸组手术节段Cobb角显著低于非后凸组(t=2.636,P=0.013)。末次随访时,两组颈椎整体活动度比较差异无统计学意义(t=1.393,P=0.168),但后凸组手术节段活动度和Cobb角均显著低于非后凸组(P<0.05)。根据末次随访时的手术节段Cobb角,后凸组局部后凸畸形9例(37.5%),非后凸组7例(14.9%),比较差异有统计学意义(χ2=4.651,P=0.031)。两组PO分级比较差异有统计学意义(Z=2.894,P=0.004);其中后凸组低等级PO 10例(41.7%)、高等级PO 14例(58.3%),非后凸组低等级PO 36例(76.6%)、高等级PO 11例(23.4%)。两组患者术前及末次随访时的JOA评分、NDI,以及末次随访时JOA改善率及Odem评分、手术前后NDI差值比较,差异均无统计学意义(P>0.05)。结论人工颈椎间盘角后凸可能会导致CADR术后远期手术节段活动度降低,局部后凸和高等级PO的发生率增高。
Objective To evaluate the influence of the shell angle of cervical artificial disc on long-term effectiveness of cervical artificial disc replacement(CADR). Methods The clinical data of 71 patients who were treated with single-level CADR with Bryan prosthesis between December 2003 and December 2007 and followed up more than 10 years, were retrospectively analyzed. There were 44 males and 27 females with an age of 26-69 years(mean, 45.9 years).According to the shell angle of the cervical artificial disc which was measured on the postoperative lateral X-ray film, the patients were divided into kyphotic group(shell angle was negative) and non-kyphotic group. The following evaluation indexes before operation and at last follow-up were compared between 2 groups. Radiographic indexes included the range of motion(ROM) of cervical spine, the ROM of operated level, Cobb angle of operated level(the negative value indicated that the segmental kyphosis occurred at operated level), paravertebral ossification(PO) grades(grades 3 and 4 were high grade PO). Clinical indexes included Japanese Orthopaedic Association(JOA) score, neck disability index(NDI),and overall effectiveness evaluation(Odom criteria). Results There were 24 patients in kyphotic group and 47 patients in non-kyphotic group. There was no significant difference in baseline data including gender, age, and operated level between 2 groups(P>0.05). All the patients in 2 groups were followed up 121-165 months(mean, 128 months). There was no significant difference in preoperative ROM of cervical spine and ROM of operated level between 2 groups(P>0.05); but the preoperative Cobb angle of operated level in kyphosis group was significantly lower than that in non-kyphotic group(t=2.636, P=0.013). There was no significant difference in ROM of cervical spine at last follow-up between 2 groups(t=1.393, P=0.168), however, the ROM and the Cobb angle of operated level in kyphotic group were significantly lower than those in non-kyphotic group(P<0.05). According to the Cobb angle of operated level at last follow-up, there were9 patients(37.5%) with segmental kyphosis in kyphotic group and 7 patients(14.9%) in non-kyphotic group, showing significant difference(χ2=4.651, P=0.031). There was a significant difference in PO grades between 2 groups(Z=2.894,P=0.004) at last follow-up. In kyphotic group, there were 10 patients(41.7%) with low grade PO and 14 patients(58.3%)with high grade PO; and in non-kyphosis group, there were 36 patients(76.6%) with low grade PO and 11 patients(23.4%)with high grade PO. There was no significant difference in JOA scores and NDI before operation and at last follow-up, and the JOA improvement rate, NDI decline, and Odom criteria score at last follow-up between 2 groups(P>0.05).Conclusion The shell angle of cervical artificial disc may lead to a decrease in the postoperative segmental ROM, and an increased occurrence of segmental kyphosis and high incidence of PO.
Objective To evaluate the influence of the shell angle of cervical artificial disc on long-term effectiveness of cervical artificial disc replacement(CADR). Methods The clinical data of 71 patients who were treated with single-level CADR with Bryan prosthesis between December 2003 and December 2007 and followed up more than 10 years, were retrospectively analyzed. There were 44 males and 27 females with an age of 26-69 years(mean, 45.9 years).According to the shell angle of the cervical artificial disc which was measured on the postoperative lateral X-ray film, the patients were divided into kyphotic group(shell angle was negative) and non-kyphotic group. The following evaluation indexes before operation and at last follow-up were compared between 2 groups. Radiographic indexes included the range of motion(ROM) of cervical spine, the ROM of operated level, Cobb angle of operated level(the negative value indicated that the segmental kyphosis occurred at operated level), paravertebral ossification(PO) grades(grades 3 and 4 were high grade PO). Clinical indexes included Japanese Orthopaedic Association(JOA) score, neck disability index(NDI),and overall effectiveness evaluation(Odom criteria). Results There were 24 patients in kyphotic group and 47 patients in non-kyphotic group. There was no significant difference in baseline data including gender, age, and operated level between 2 groups(P>0.05). All the patients in 2 groups were followed up 121-165 months(mean, 128 months). There was no significant difference in preoperative ROM of cervical spine and ROM of operated level between 2 groups(P>0.05); but the preoperative Cobb angle of operated level in kyphosis group was significantly lower than that in non-kyphotic group(t=2.636, P=0.013). There was no significant difference in ROM of cervical spine at last follow-up between 2 groups(t=1.393, P=0.168), however, the ROM and the Cobb angle of operated level in kyphotic group were significantly lower than those in non-kyphotic group(P<0.05). According to the Cobb angle of operated level at last follow-up, there were9 patients(37.5%) with segmental kyphosis in kyphotic group and 7 patients(14.9%) in non-kyphotic group, showing significant difference(χ2=4.651, P=0.031). There was a significant difference in PO grades between 2 groups(Z=2.894,P=0.004) at last follow-up. In kyphotic group, there were 10 patients(41.7%) with low grade PO and 14 patients(58.3%)with high grade PO; and in non-kyphosis group, there were 36 patients(76.6%) with low grade PO and 11 patients(23.4%)with high grade PO. There was no significant difference in JOA scores and NDI before operation and at last follow-up, and the JOA improvement rate, NDI decline, and Odom criteria score at last follow-up between 2 groups(P>0.05).Conclusion The shell angle of cervical artificial disc may lead to a decrease in the postoperative segmental ROM, and an increased occurrence of segmental kyphosis and high incidence of PO.
引文
1 Chin KR,Pencle FJ,Seale JA,et al.Clinical outcomes of outpatient cervical total disc replacement compared to outpatient anterior cervical discectomy and fusion.Spine(Phila Pa 1976),2017,42(10):E567-E574.
2 Dejaegher J,Walraevens J,van Loon J,et al.10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis.Eur Spine J,2016,26(4):1191-1198.
3 Zhao Y,Zhang Y,Sun Y,et al.Application of cervical arthroplasty with Bryan cervical disc:10-year follow-up results in China.Spine(Phila Pa 1976),2016,41(2):111-115.
4 Lee JH,Kim JS,Lee JH,et al.Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation.Spine J,2014,14(7):1199-1204.
5 Quan GM,Vital JM,Hansen S,et al.Eight-year clinical and radiological follow-up of the Bryan cervical disc arthroplasty.Spine(Phila Pa 1976),2011,36(8):639-646.
6 Helgeson MD,Bevevino AJ,Hilibrand AS.Update on the evidence for adjacent segment degeneration and disease.Spine J,2013,13(3):342-351.
7 韩骁,田伟,刘波,等.颈椎退行性疾病Bryan间盘置换术后椎旁骨化影响因素分析.山东医药,2017,57(4):13-16.
8 Yi S,Oh J,Choi G,et al.The fate of heterotopic ossification associated with cervical artificial disc replacement.Spine(Phila Pa1976),2014,39(25):2078-2083.
9 Tu TH,Wu JC,Huang WC,et al.Heterotopic ossification after cervical total disc replacement:determination by CT and effects on clinical outcomes.J Neurosurg Spine,2011,14(4):457-465.
10 Tian W,Wang H,Yan K,et al.Analysis of the factors that could predict segmental range of motion after cervical artificial disc replacement:a 7-years follow-up study.Clin Spine Surg,2016,30 (5):E603-E608.
11 Tu TH,Wu JC,Huang WC,et al.The effects of carpentry on heterotopic ossification and mobility in cervical arthroplasty:determination by computed tomography with a minimum 2-year follow-up:Clinical article.J Neurosurg Spine,2012,16(6):601-609.
12 Hukuda S,Mochizuki T,Ogata M,et al.Operations for cervical spondylotic myelopathy:a comparison of the results of anterior and posterior procedures.J Bone Joint Surg(Br),1985,67(4):609-615.
13 伍少玲,马超,伍时玲,等.颈椎功能障碍指数量表的效度与信度研究.中国康复医学杂志,2008,23(7):625-628.
14 Fong SY,Duplessis SJ,Casha S,et al.Design limitations of Bryan disc arthroplasty.Spine J,2006,6(3):233-241.
15 Walraevens JR,Liu B,Sloten JV,et al.Postoperative segmental malalignment after surgery with the Bryan cervical disc prosthesis:is it related to the mechanics and design of the prosthesis?J Spinal Disord Tech,2010,23(6):372-376.
16 Yi S,Shin HC,Kim KN,et al.Modified techniques to prevent sagittal imbalance after cervical arthroplasty.Spine(Phila Pa 1976),2007,32(18):1986-1991.
17 Kim SW,Paik SH,Castro PA,et al.Analysis of factors that may influence range of motion after cervical disc arthroplasty.Spine J,2010,10(8):683-688.
18 Hacker B,Papadopoulos S,Sasso R.Regarding;Bryan disc related cervical kyphosis.Spine J,2007,7(1):139.
2 Dejaegher J,Walraevens J,van Loon J,et al.10-year follow-up after implantation of the Bryan Cervical Disc Prosthesis.Eur Spine J,2016,26(4):1191-1198.
3 Zhao Y,Zhang Y,Sun Y,et al.Application of cervical arthroplasty with Bryan cervical disc:10-year follow-up results in China.Spine(Phila Pa 1976),2016,41(2):111-115.
4 Lee JH,Kim JS,Lee JH,et al.Comparison of cervical kinematics between patients with cervical artificial disc replacement and anterior cervical discectomy and fusion for cervical disc herniation.Spine J,2014,14(7):1199-1204.
5 Quan GM,Vital JM,Hansen S,et al.Eight-year clinical and radiological follow-up of the Bryan cervical disc arthroplasty.Spine(Phila Pa 1976),2011,36(8):639-646.
6 Helgeson MD,Bevevino AJ,Hilibrand AS.Update on the evidence for adjacent segment degeneration and disease.Spine J,2013,13(3):342-351.
7 韩骁,田伟,刘波,等.颈椎退行性疾病Bryan间盘置换术后椎旁骨化影响因素分析.山东医药,2017,57(4):13-16.
8 Yi S,Oh J,Choi G,et al.The fate of heterotopic ossification associated with cervical artificial disc replacement.Spine(Phila Pa1976),2014,39(25):2078-2083.
9 Tu TH,Wu JC,Huang WC,et al.Heterotopic ossification after cervical total disc replacement:determination by CT and effects on clinical outcomes.J Neurosurg Spine,2011,14(4):457-465.
10 Tian W,Wang H,Yan K,et al.Analysis of the factors that could predict segmental range of motion after cervical artificial disc replacement:a 7-years follow-up study.Clin Spine Surg,2016,30 (5):E603-E608.
11 Tu TH,Wu JC,Huang WC,et al.The effects of carpentry on heterotopic ossification and mobility in cervical arthroplasty:determination by computed tomography with a minimum 2-year follow-up:Clinical article.J Neurosurg Spine,2012,16(6):601-609.
12 Hukuda S,Mochizuki T,Ogata M,et al.Operations for cervical spondylotic myelopathy:a comparison of the results of anterior and posterior procedures.J Bone Joint Surg(Br),1985,67(4):609-615.
13 伍少玲,马超,伍时玲,等.颈椎功能障碍指数量表的效度与信度研究.中国康复医学杂志,2008,23(7):625-628.
14 Fong SY,Duplessis SJ,Casha S,et al.Design limitations of Bryan disc arthroplasty.Spine J,2006,6(3):233-241.
15 Walraevens JR,Liu B,Sloten JV,et al.Postoperative segmental malalignment after surgery with the Bryan cervical disc prosthesis:is it related to the mechanics and design of the prosthesis?J Spinal Disord Tech,2010,23(6):372-376.
16 Yi S,Shin HC,Kim KN,et al.Modified techniques to prevent sagittal imbalance after cervical arthroplasty.Spine(Phila Pa 1976),2007,32(18):1986-1991.
17 Kim SW,Paik SH,Castro PA,et al.Analysis of factors that may influence range of motion after cervical disc arthroplasty.Spine J,2010,10(8):683-688.
18 Hacker B,Papadopoulos S,Sasso R.Regarding;Bryan disc related cervical kyphosis.Spine J,2007,7(1):139.